Health Access Nurturing Development Services (HANDS) Program

HANDS is a voluntary home visiting program designed to improve pregnancy and birth outcomes; maximize children’s growth and development; create healthy, safe homes; and promote self-sufficient families. The program serves expectant and new parents facing multiple challenges and stressors and who enroll during pregnancy or any time before a child is 90 days old. A trained home visitor conducts prenatal and postnatal home visits focused on strengthening families by building parenting skills, fostering secure parent-child attachment, and facilitating family goal setting. Home visitors also provide targeted support through resource referrals with the aim of strengthening the family’s resilience by building the family’s social connections within their community and offering concrete assistance. The level of services offered to families varies from weekly to quarterly based on the needs of the family and the pace at which they progress through the program.

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The Health Access Nurturing Development Services (HANDS) program aims to support families as they build healthy and safe environments for children’s optimal growth and development. The program is based on several key assumptions:

• All families have strengths.
• Families are responsible for their children.
• Families are the primary decision makers regarding their children.
• Communities recognize their roles in children’s lives.
• Communities recognize that all children must succeed.
• Prevention and early intervention improve the community’s well-being.
• Public and private partnerships are vital to a successful program.

The HANDS program is a voluntary statewide home visitation program authorized by the Kentucky Legislature in 2000. The Department for Public Health administers the program through local health departments and contracted sites in every county. Within the Department of Public Health is a state office team consisting of:

• A program supervisor,
• a continuous quality improvement coordinator, 
• a professional development coordinator, 
• epidemiologists, 
• budgetary staff, 
• regional quality assurance specialists (QAs), 
• regional technical assistance specialists (TAs), 
• a Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grant administrator, and 
• administrative staff. 

In addition, trainers provide guidance to HANDS staff throughout the state. 

The state office regional teams consist of QAs and TAs who have experience in the HANDS program and have completed the HANDS QA training or TA training, respectively. Both QAs and TAs work with other HANDS team members to identify and address concerns, promote program growth, and evaluate outcomes. QAs assess site productivity and implementation through annual quality assurance site visits to each HANDS site. Sites receive written documentation about their overall performance and areas for growth. TAs support the implementation of the model, with the goal of consistent implementation at local HANDS sites throughout the state. TAs help sites prioritize needs based on areas for growth identified during the QA site visit.

HANDS serves new and expectant parents who enroll during pregnancy or any time before a child is 90 days old. Eligible families face multiple challenges and stressors related to their parenting experiences and expectations, child and family health, social environment, family life, and basic needs.

HANDS is designed to improve pregnancy and birth outcomes; enhance children’s growth and development; create healthy, safe homes; and promote self-sufficient families.

HANDS home visitors initiate an assessment process to determine a family’s eligibility and identify their strengths and needs. This process may start during pregnancy or any time before the child is 90 days old. To assess eligibility, the home visitor discusses the following topics with the family: (1) prenatal care and prior pregnancies; (2) tobacco, alcohol, or substance misuse; (3) mental health history such as depression, postpartum depression, medications, and counseling; (4) the child’s development; (5) access to supports such as family and social networks; (6) marital or family stressors, including violence and childhood trauma; (7) basic needs such as employment, income, and housing; and (8) current stressors such as parenting expectations and transportation. If the assessment indicates a family may benefit from HANDS services, the family is offered home visiting services through HANDS. If a family is ineligible for services, the home visitor shares information about community resources. 

For families engaged in home visits, trained home visitors provide services using the Growing Great Kids® curriculum. They also conduct developmental and social-emotional screenings for children and screenings for domestic violence and perinatal depression in parents. Services focus on strengthening families by building parenting skills, fostering secure parent-child attachment, and facilitating family goal setting. Home visitors also provide targeted support through resource referrals with the aim of strengthening the family’s resilience by building the family’s social connections within their community and offering concrete assistance. Health promotion is also a key focus of HANDS home visitation, and home visitors encourage families to establish medical homes, maintain health insurance coverage, and engage in preventative services such as well-child visits.

The home visitor, supervisor, and family determine the intensity of services based on a family’s progression through the HANDS program and their assessed need. Families progress as they successfully meet criteria outlined in the HANDS “level” system, which ranges from a high intensity (weekly visits) to a low intensity level (quarterly visits). All families are not expected to move through all levels. Regardless of level, home visits last about an hour. Level intensity determines whether families are eligible to participate until the child’s second or third birthday. Please contact the model developer for additional information about the length of the HANDS program.

Please contact the model developer for information about adaptations or enhancements to the model and the process for considering modifications to the model.

HANDS is implemented by Kentucky’s Department for Public Health through local public health agencies or a local health or human service agency that serves as a subcontractor to local public health agencies.

HANDS programs must adhere to the model’s guiding principles. Please contact the model developer for additional information about the guidelines.

Local agencies must employ home visitors and supervisors. Programs may have additional staff roles to support intake, data entry, or other program functions.

Kentucky regulations state that both professionals and paraprofessionals may serve as home visitors. The supervisor must be a licensed nurse or social worker. 

Supervision is required for all employees. Supervisors oversee day-to-day program operations to ensure adherence to HANDS policies and procedures. Supervisors support and promote quality home visitation services, healthy supervisor-to-staff-to-family relationships, and staff development. They also work to reduce staff burnout and improve staff retention. Please contact the model developer for information on the mode and frequency of supervision and to learn about support that is offered to supervisors. 

Before providing services, home visitors must complete core training on the HANDS model and curriculum, along with trainings on preventing and recognizing child abuse with a specific focus on pediatric abusive head trauma. Additional mandatory training topics are required at set intervals. Supervisors must complete all required home visitor trainings in addition to specialized training on supervision. Please contact the model developer for additional information about the pre-service training and ongoing professional development requirements.

Health Access Nurturing Development Services (HANDS)
Cabinet for Health and Family Services
275 East Main Street
Frankfort, KY 40621
Phone: (502) 564-4830
Website: www.chfs.ky.gov/agencies/dph/dmch/ecdb/Pages/hands.aspx